Differences in maintenance vs. acute care between a rural and urban Mississippi Medicare Advantage population with diabetes; a cross-sectional analysis

Objectives: To describe compliance with diabetes care screenings and health care resource utilization (HCRU) among rural and urban residents of Mississippi across the continuum of diabetes severity.

Methods: People insured by a Medicare Advantage health plan in Mississippi identified as having diabetes based on a combination of ICD-9 codes, lab results, and pharmacy claims were included.  Severity (low, medium, high) was based on the Diabetes Complication Severity Index.  Rural-Urban Commuting Area Codes determined geography status. Compliance with annual proteinuria screens, low density lipoprotein (LDL) tests, and hemoglobin A1C as well as all-cause physician office visits (PO visits) and ER visits per 1,000 was reported.  Statistical significance was examined using t-tests and chi-square tests with a priori level of 0.05.

Results: In the sample population (n=13,040), nearly 2 in 5 lived in rural areas (39.7%), and 71.9% of the sample had low severity diabetes. Among those with low severity, the rural cohort had significantly lower compliance with screenings than those in urban areas (p<0.01): proteinuria 45% vs. 51%, LDL 64% vs. 69%, and A1C 70% vs. 75%, respectively. The low severity, rural cohort trended towards fewer PO visits (7,605 vs. 7,912, p<0.28), and more ER visits (515 vs. 471, p<0.01) per 1,000 than their urban counterparts. The observed trends in the low severity group were generally similar in the medium and high severity groups; PO and ER visits were higher as severity increased.

Conclusions: Diabetes-specific population health strategies should address disparities in maintenance vs. acute HCRU among rural and urban residents.